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Dr. Andrew Rynne

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Bloating, diarrhea, constipation. EGD shows gastritis. CT scan shows splenule. Stool sample shows fat positive. Problem?

Answered by
Dr. Charles S Narasi


Practicing since :1962

Answered : 693 Questions

Posted on Fri, 12 Apr 2013 in Digestion and Bowels
Question: Hi- my name is XXXXXXX and I have had bloating/ episodes going back and forth from diarrhea and constipation. I get really bloated at times, and feel like CRAP. The doctor did a few tests on me and this is what it included
Colonoscopy- it came back normal with XXXXXXX hemmroids found only- biopsies done- normal no findings
EGD- -Found gastritis - otherwise normal also did biopsies
HIDA Scan- Normal it states "Normal Hepatobiliary scan with normal gallbladder ejection fraction of 47%
Abdominal Cat Scan with constrast- Normal it stated "The lung bases are clear. The Liver,spleen,
gallbladder,pancreas,kidneys, and adrenal glands are within Normal limits. A small splenule is noted anterior to the spleen. No mass or adenopathy is seen. No bowel wall thickening, edema, pneumoperitoneum or ascites is evident. The uterus and adnexa are unremarkable. No osseous is seen
Lipase- Normal range
Amylace- Normal range
Ultrasound of the right upper quandrant said "Liver is unremarkable in contour, shape and parenchmal echogenicity. There is no evidence of intra or extrahepatic bililary dilation with the CBD measuring 2mm. Gall bladder is unremarkable with no evidence of Cholelithiasis. The Visualized portion of the pancreas is unremarkable with the body and tail not well visualized due to overlying bowel gas. Screening images of the right kidney demonstrate no XXXXXXX hydronephrosis and unremarkable cortical echogenicity. The right Kidney measures 10.8cm in length Impression : Unremarkable rruq ultrasound
He did some kind of autoantibody for autoimmune pancreatitus- came back negetive
then he did stool samples for OvaParasites- negetive
stool sample blood- negetive
The only positive was stool sample for fat -Positive
Celiec disease- serum and biopsy -negetive
Hpylori Biopsy-negetive
Hemaglobin A1c -normal 5.6
CBC- Normal except very mild anemia Hemaglobin was 11.8 Hematocrit 36.2, wbc-5.9
BMP-normal last one bilirubin was 0.4, albumin 4.1 Sodium 143 Potassium 4.2 Calcium 9.6 Chloride 106 BUN 10 Creatinine 0.8 ,glucose 78, total protien 8.1 Alkaline Phos 50
Albumin that was in the BMP or CBC (forget which one thats in) was normal range
Carcinoid- was ruled out by a weird blood test.
All my thyroid levels were chcecked including TSH T4 T3 T7 and thyroid antibodies all normal.... (this was checked in depth due a nodule- which was benign)
I have had many chest Xrays- all negetive

All he did was leave me a message telling me theres fat in my stool and we will talk on monday- but when I look it up it could mean pancreatic cancer, bililary tract cancer, Whipples disease, all of these fatal things, all sorts of cancers and odd disorders :( which makes me nervous

My history prior to this was I had a premature birth of a baby in october , while in the hospital they gave me vancomycin,zyvox and I think zosyn for the fear of a uterine infection (which I did not have) for 3 days i had a temp of 99.5 and that was dude to a sinus infection but htey wouldnt believe me. could that have wiped out my enzymes? could I have Small bowel overgroweth?. Otherwise I have been a very healthy person my whole life. I do not have any jaundice seen in my skin or eyes. ive lost a total of 14lbs since december im 5'3
Answered by Dr. Charles S Narasi 1 hour later
I am glad to see that you have provided very extensive
reports of what has been done so far. I am a little concerned
about your weight loss and mild anemia. All your other blood work
looks fine. They did find fat in your stool. What you need is 72 hour
quantitative stool for fat which would indicate if you have fat
malabsorption and pancreas problem. Eventhough you have had
a normal appearing pancreas on the sonogram, you need a little
more sophisticated study to look at pancreas. This might include
CT-Scan of the pancreas and or MRCP to be followed by ERCP
(Endoscopic retrograde cholangio pancreatography) where they
can get into the duct of the pancreas , collect fluid and also do
a biopsy to determine if you have pancreas problems including
pancreatic cancer.
From what I see, you have had a very good work up so far.
But you need to have these additional studies to narrow down
what is causing your symptoms. You asked about bacterial
overgrowth syndrome. You can have bloating, gas, diarrhea etc
with this , but antibiotics usually control the symptoms.
When you were on the Vancomycin and Zosyn, if you felt better
that might indicate or support that.I also suggest that you get some cancer
markers such as CEA and CA-129 etc.
I hope you can discuss these with your doctor and take proper
I wish you the very best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Charles S Narasi 6 minutes later
Being 26 years old would that have a good indication of pancreatic cancer ? Most of my problems started after the premature birth of my baby; 2 weeks after her birth this started. are there other reasons for fat malabsorbtion other than Pancreatic Cancer? I am very nervious about that fact & wish it wasn't a possibility.
Answered by Dr. Charles S Narasi 7 minutes later
You are only in your twenties and the possibility
of pancreatic cancer is very low at this age group.
It is possible that you may have have what is called
"Pancreatic insufficiency " probably from recurrent
inflammation. If you have not had a small bowel
x-ray series, I would suggest you get that to find
out if you have any signs of early Crohn's disease
that might account for malabsorption.
I wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Charles S Narasi 3 minutes later
THank you- I think the doctor told me the next step was going to be a barium swallow test with a camera to look at the area of my bowels that the colonoscopy and EGD cannot see? Maybe thats the same test your talking about- the doctor just stated ont he phone he wanted to start me on a medication for pancreatic enzymes, I was wondering if I could of Depleted those enzymes by recieving very potent antibiotics when I didn't have an actual infection, but maybe not.
Answered by Dr. Charles S Narasi 10 hours later
I think what your doctor is talking about is called
"Capsule Endoscopy" where a small capsule with
electronic devices is swallowed and after the capsule
travels the entire intestinal tract , it comes out in the
During this process the camera can take hundreds of
pictures of all of 22 feet of small intestine and the large
bowel. After the passage of the capsule , the transmitting
device is attached to the computer which can analyze all
the pictures and show any hidden abnormalities such as
Croh'n disease etc.
I do not believe the antibiotics can affect the enzymes.
Antibiotics can cause a type of colitis called "C.Difficile Colitis"
and one of the treatments is Vancomycin drug.
I wish you the very best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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